Defining successful treatment outcome in depression using the PHQ-9: A comparison of methods
Defining successful treatment outcome in depression using the PHQ-9: A comparison of methods
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DOI：
10.1016/j.jad.2010.04.030
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发表时间：
2010-12-01
影响因子：
6.6
通讯作者：
Richards, David
中科院分区：
文献类型：
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作者：
McMillan, Dean;Gilbody, Simon;Richards, David
背景：虽然PHQ-9被广泛应用于初级保健，但对其在量化改善方面的表现知之甚少。PHQ-9最初的验证研究将临床显著变化定义为治疗后评分：59加上改善50%，但尚不清楚这与定义成功结果的其他理论上知情的方法有何关系。在社区级抑郁症干预的临床试验中，我们比较了一系列临床显著变化的定义(原始定义、无症状标准、可靠和临床显著变化标准a、b和c)。结果：标准定义与其他定义具有良好的一致性(kappa>；0.60)，与诊断访谈具有中等的一致性(kappa=0.58)。标准定义与可靠且临床显著的改变标准c密切对应，c是临床和非临床分布重叠时量化改善的推荐方法。限制：缺乏随访数据意味着使用无症状标准而不是缓解或恢复标准。结论：标准定义与可靠且临床显著的改变标准c之间的密切一致性为改善的标准定义提供了一定的支持。然而，使用可靠的变化指数可能比使用50%的改进更可取。根据无症状范围和较低的PHQ-9评分，缓解状态可能提供一个有用的额外的临床变化类别。(C)2010爱思唯尔B.V.保留所有权利。
Background: Although the PHQ-9 is widely used in primary care, little is known about its performance in quantifying improvement. The original validation study of the PHQ-9 defined clinically significant change as a post-treatment score of :59 combined with improvement of 50%, but it is unclear how this relates to other theoretically informed methods of defining successful outcome. We compared a range of definitions of clinically significant change (original definition, asymptomatic criterion, reliable and clinically significant change criteria a, b and c) in a clinical trial of a community-level depression intervention.Method: Randomised Control Trial of collaborative care for depression. Levels of agreement were calculated between the standard definition, other definitions, and gold-standard diagnostic interview.Results: The standard definition showed good agreement (kappa > 0.60) with the other definitions and had moderate, though acceptable, agreement with the diagnostic interview (kappa=0.58). The standard definition corresponded closely to reliable and clinically significant change criterion c, the recommended method of quantifying improvement when clinical and non-clinical distributions overlap.Limitations: The absence of follow-up data meant that an asymptomatic criterion rather than remission or recovery criteria were used.Conclusion: The close agreement between the standard definition and reliable and clinically significant change criterion c provides some support for the standard definition of improvement. However, it may be preferable to use a reliable change index rather than 50% improvement. Remission status, based on the asymptomatic range and a lower PHQ-9 score, may provide a useful additional category of clinical change. (C) 2010 Elsevier B.V. All rights reserved.